Memorandum submitted by the NHS Confederation
The Confederation brings together the organisations
that make up the modern NHS across the UK. Our membership comprises
92% of NHS organisations across the UK. We work with our members
to transform health services and health for the better. As an
independent driving force, we do this by:
influencing policy and public debate;
connecting health leaders through
involving our members in our work;
representing NHS employers.
Our evidence sets out our general views, based
on feedback from a cross section of our member forums, on the
current situation regarding the implementation of the proposed
changes. Where appropriate, we have also included more specific
comments on the questions asked.
Whether charges for treatments, including prescriptions,
dentistry and optical services; and hospital services (such as
telephone and TV use and car parking) are equitable and appropriate?
1. The current system of Prescription Charges
is based on a mixture of medical need, social need and low income.
This mixture potentially causes confusion and inequalities.
2. There are a number of anomalies relating
to exemptions for particular types of patient that need to be
addressed to make the system simpler and more obviously fair:
Conditions for which exemptions do
not apply include asthma, Chronic Obstructive Pulmonary Disease
and Chronic Heart Disease, which can be just as much a threat
to a patient's health as those which are exempt from charge.
Exemptions apply to all prescriptions
a patient may receive rather than being specific to a medical
condition. It may be more equitable to make only the long-term
medical condition for which a patient is being treated exempt
rather than all the prescriptions that a patient may be issued
with for un-associated acute conditions.
The exemption from charge for medical
treatment is not linked to income in the case of pregnancy, which
may not necessarily present as much a risk to the mother's or
infant's health as it did in the past.
3. Patient's clinical care may be affected
by the associated prescription charges, as they may be put in
a position whereby they are inappropriately having to restrict
the treatment they are receiving on the grounds of cost.
4. Prescription charges are usually defined
by each item prescribed on a prescription form. Certain multiple
packs do exist which give rise to multiple charges, for example,
helicobacter pylori irradiation therapy and many of the hormone
replacement therapies. Although presented as a single patient
pack, they represent a course of treatment consisting of a variety
of different drugs, for which there is a charge for each different
preparation (up to a maximum of three charges). Similar circumstances
can arise from the prescribing of certain forms of equipment.
Whether the system of charges is sufficiently
5. Transparency is an issue. Patients are
often unaware of the prescription charge until they are put in
a position where they need a medical treatment. They also often
associate the charge with profit being made with whoever dispenses
the prescription, rather than recognise it as a usage charge similar
to a tax.
Whether charges should be abolished?
6. Charges do generate income that would
need to be replaced from other sources or, given the current state
of public finances, found by reducing other types of services.
The benefit of a reduction in charges may be less than the negative
impact on other users of services. The effect of this on inequalities
would need to be considered carefully.
7. Our members have not indicated that the
costs of administering charges, verifying exemptions, collecting
cash, recovering bad debts and auditing the system are a major
issue for them and so, whilst there may be some savings if no
charges are made, it is not clear that this would be a significant
8. A significant reason why co-payment is
used in other healthcare systems is to control utilisation and
create a sense of responsibility to avoid the problem of inefficient
over-consumption of healthcare. To do this, charges need to apply
universally and be low enough not to deter appropriate use. The
evidence seems to suggest that whilst charges can reduce inappropriate
use, they may also deter patients from making appropriate use
of services. The UK has a low rate of costs being a factor or
being the main reason why patients do not fill their prescriptions.